Monday, February 27, 2012

The Stage 2 Standards and Certification NPRM

On Friday, ONC released the Standards and Certification NPRM, the companion to the the CMS Meaningful Use Stage 2 NPRM.

Here's a bookmarked PDF  - thanks to Tony Panjamapirom of the Advisory Board.

In my view, the NPRM is a work of art, reflecting the work of the HIT Standards Committee, the S&I Framework, and  the multi-stakeholder consensus that fewer, more complete standards with less optionality will lead to greater interoperability.

I've always thought of healthcare standards as having three components -  content, vocabulary, and transport.

For content, the NPRM specifies HL7 2.51 for lab results, syndromic surveillance, reportable lab, and immunizations (HL7 2.31 is not longer an option).   For summary transactions, the Consolidated CDA is the only recommended standard.   (CCR and CCD/C32 are no longer specified).    NCPDP is specified as standard for the exchange of prescription information between entities, including for discharge medications.

For vocabularies, the NPRM specifies a single vocabulary per domain, just as HITSC recommended
Medications - RXnorm
Problem Lists - SNOMED-CT
Discharge Diagnosis - ICD10-CM
Immunizations - CVX
Demographics preferred language - ISO 639-1
Demographics preliminary cause of death ICD10-CM

For transport, two standards are available, consistent with the Direct Project - SMTP/SMIME and SOAP.   A RESTful option is not specified, but ONC recognizes that a RESTful implementation guide may be available in the future.

The 2014 edition of the Standards and Certification NPRM eliminates the "OR", since this standard OR that standard implies that vendors need to support both, creating an "AND" for implementers.  

The ONC NPRM is clear, unambiguous, forward looking and reasonable.   Congrats to the team who wrote it.


Jan Hazelzet said...

John, you mentioned that CCR/CCD are no longer specified as a standard for clinical summary. Does this mean they are no longer advised to use?

Jan Hazelzet

MikeLGagnon said...

I do not think that any further deployment of Direct is a good idea. I questioned it when they came out with it and it is worse now. I am involved with several HIEs and all of them, plus all the ones I talk to, thing Direct is slowing down the creation of the networks we need to truly need (HIEs). How many use cases will eventually be on Direct? Maybe 10 out the hundreds that will be on the network. ONC should get off of their insistence on this outdated technology.

Anonymous said...

I have heard similar comments from other Mike, but the reality is that Direct fills a gap that is not otherwise fullfilled. Essentially, HL7 and other traditional healthcare messaging protocols supported system to system messaging driven by events, for example, every time a patient is registered send an update message. XDS supports query and response by a provider, i.e. find a patient, find what there is about the patient, retrieve documents. Direct supports user to user communication, such as that required to really support a CCD the way it was intended to be used. While many may feel that it subverts some of the aims of traditional HIEs and RHIOs, the reality is there is no alternative for directed person to person communications.